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HealthPayerIntelligence News

Senate Has Released Bill to Revise ACA Repeal Legislation

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The Senate has released the working draft of the Better Care Reconciliation Act of 2017, revising the recently House-passed AHCA.   Both bills aim to repeal and replace the Affordable Care Act (ACA), which was passed in 2010. The AHCA...

Healthcare Spending Growing at Slower Than Expected Rate

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Expenditures on healthcare grew at a historically low rate between 2009 and 2013, according to a recent report, defying the conventional wisdom that healthcare spending has skyrocketed.  A Robert Wood Johnson Foundation report looked at...

Balance Billing Hits Patients with Surprise Healthcare Costs

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Patients who received treatment within an in-patient network can still face surprise healthcare costs from balance billing. Balance billing occurs when an individual receives an unforeseen bill for treatment by an out-of-network provider, even...

Medica Will Stay in NE and IA Health Insurance Exchanges

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Medica has announced plans to stay in the Nebraska and Iowa health insurance exchanges for 2017.   Although committed to the Nebraska exchange, the payer had previously indicated it was going to leave the Iowa marketplace. Both states...

Anthem BCBS Expands Value-Based Care Options with Premier Health

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Anthem Blue Cross Blue Shield has partnered with Ohio-based Premier Health to expand its value-based care offerings to its employer-based, individual and Medicare Advantage members. The agreement aligns Premier’s population health model...

Cigna Re-enters Medicare Advantage Market With CMS Approval

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Cigna announced in a securities filing that it had received the green light from CMS to begin offering Medicare Advantage plans again after an 18 month suspension.  The insurer had been banned from offering the popular Medicare supplement...

Flexibility and Innovation Needed To Control Medicaid Costs

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As state and federal regulators debate the future of Medicaid spending, health researchers have identified the need for flexibility and innovation in Medicaid policies involving payment models, delivery of care and drug costs. The recommendations...

CMS Outlines Special Enrollment Period Rules for ACA Exchanges

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Starting on June 23, 2017, CMS will be enacting its new rules regarding special enrollment periods (SEP) for the ACA marketplace.  The agency released the new special enrollment rules earlier this year that will alter participation criteria...

Aetna, Oscar Health Create Provider-Based Health Insurance Plans

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Two new provider-based health insurance plans will be available in 2018, as Aetna and Oscar Health align with Sutter Health and the Cleveland Clinic, respectively, to offer new coverage options for patients.  The provider-based plans would...

AMA, AHA Call for Stronger Patient Insurance Protections

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The American Medical Association (AMA) has joined seven prominent health industry groups in calling for the Senate to address patient protection concerns regarding health insurance coverage.  The move by eight of the nation’s leading...

Cigna, CVS MinuteClinics Partner for Expanded Healthcare Access

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Cigna and CVS Health have partnered to launch Cigna Health Works for expanded healthcare access for the payers employer-based health plan members.  The launch is currently limited to certain markets only. Cigna Health Works will align members...

Facing an Empty Exchange, Iowa Suggests Statewide Insurance Plan

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If Iowa’s health insurance exchanges are completely abandoned, the state will request that the federal government allow the establishment of a state health care plan for 2018. If approved by CMS, the stopgap measure would create the Iowa...

Medicaid Enrollment a “Lifeline” for Rural Residents, Children

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Medicaid enrollment rates are highest for adults and children in small town and rural areas, providing a “lifeline” for low-income beneficiaries, according to a new analysis by the Georgetown University Center for Children and...

Centene Will Enter Health Insurance Exchanges in 3 New States

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Centene Corporation will expand its presence in a number of state health insurances exchanges in 2018, building on its successful 2017 marketplace results.  The payer is planning to enter the Kansas, Missouri and Nevada...

Employer Health Plans See Spike In Out-of-Pocket Costs

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The National Center for Health Statistics study found a double-digit increase in the use of high-deductible employer health plans has generated increased economic strain for members. Beneficiaries reported struggling to pay medical bills or delaying...

3 Whistleblower Suits Net over $60 Million in Medicare Fraud

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Whistleblower lawsuits alleging Medicare fraud have been settled against two diagnostic testing companies, and a California doctor who was alleged to have falsely diagnosed cancer as a means to bill Medicare for expensive surgeries. Medicare...

High Costs, Little Return are Hurting Health Insurers under ACA

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High cost beneficiaries, risk adjustment methodologies, and insufficient capital are the top three issues facing health insurers today, according to MinuteMan CEO Tom Policelli.  As the national debate over the future of the ACA and potential...

ACA Medicaid Expansion Boosted Care Access, Patient Outcomes

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Low-income adults taking advantage of the Affordable Care Act’s Medicaid expansion experience more financial stability and better outcomes, according to a new study from the Harvard T. H. Chan School of Public Health. “Our four years...

Payers Leaving Affordable Care Act Insurance Exchanges in 2017

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Questions over the future of the Affordable Care Act (ACA) and its cost-sharing reduction (CSR) payments have prompted many payers to abandon ACA state health insurance exchanges in part or entirely in 2017.  Insurers cited the usual suspects...

PA Payer Market Stable, but OH Loses ACA Exchange Participants

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Pennsylvania and Ohio are having very different experiences with their Affordable Care Act health insurance exchanges as they move into 2018. While Pennsylvania’s existing five payers will continue to offer exchange plans at roughly the...

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